Friday, July 8, 2011

Why Black Women Need Midwives

I write this post with tears in my heart, as the realization of just how profound the maternal mortality rate may be. I’ve had it on my mind to write this post, but was never able to fully motivate myself to write it. You see, I grew up without a mother, so this hits close to home, while I did not lose my mother during childbirth, I lost her way too soon, and understand the very real pain of being motherless. No one knows the full extent of this issue as maternal mortality rate is not required to be reported on a national level. The information that is reported could only be a small reflection of a bigger reality.

Saying this, the maternal mortality rate in this country simply does not justify our position as a technology-advanced country.

…women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries. For example, the likelihood of a woman dying in childbirth in the USA is ﬁve times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. More than two women die every day in the USA from pregnancy-related causes.

And we’re only speaking generally…worse still, the statistics for black gestating women are horribly worse. The report continues to share that …

African-American women are at especially high risk; they are nearly four times more likely to die of pregnancy-related complications than white women. Even for white women in the USA, however, the maternal mortality ratios are higher than for women in 24 other industrialized countries. These rates and disparities have not improved in more than 20 years. Maternal mortality ratios have actually increased from a low of 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. While some of the increase may be due to improved data collection, the fact that maternal mortality ratios have doubled is a cause for concern.

The question becomes, why the differing ratios between races? Especially considering that African American women are a minority as a race, yet has extremely high maternity ratios.

New government data shows that for 2005-2007, the maternal mortality ratio (deaths per 100,000 live births) was highest among non-Hispanic black women (34.0), followed by American Indian/Islanders (11.0), non-Hispanic whites (10.4), and Hispanics (9.6).43 Deadly Delivery found that women of color are more likely to die in pregnancy or childbirth than women from other sections in access to health care and information, discrimination and inappropriate treatment, and socioeconomic disparities.

I’ve read a few articles on the subject, Doctors are quick to point (blame) AA are usually low-income and lack insurance. While that may be true in some cases, I have to beg to differ. I personally know some women who are well off, intelligent and have excellent insurance coverage, yet have had cesareans. I’ve watched TLC’s “A Baby Story” and shows with similar theme, and I don’t think I’ve seen an episode where an AA woman gave birth vaginally. Just about every AA woman I’m personally aware of has had a cesarean, only a handful few have given birth vaginally. The Amnesty report, “Deadly Delivery” says the top cause of maternal mortality is an embolism.

Venous air embolism (VAE) is the entrapment of air or medical gases into the venous system causing symptoms and signs of pulmonary vessel obstruction. The incidence of VAE during cesarean delivery ranges from 10 to 97% depending on surgical position or diagnostic tools, with a potential for life-threatening events.

With the rise in cesarean rates, approximately 30% for the general population and even higher for AA moms, why are cesareans treated like a flu shot? I realize what I’m about to state is an uncomfortable statement for some of you, but discrimination is alive and well for women of color. We may have taken down the segregated signs along time ago, but those signs still exist in health care office. The numbers speak for themselves.

Speaking from personal experience, I hated my “prenatal” visits when I was planning for a hospital birth. My doctor was smart-mouthed and condescending. That wasn’t my issue though, she constantly told me that AA are usually at a higher risk for (fill in the blank) so I needed to have a certain invasive and risky test. I turned down some of them, but now as I’ve experienced the empowerment and confidence to birth, I can’t help but wonder how oft is that “excuse” used to implement unnecessary invasive and risky procedure such as a cesarean?

As an observer, cesareans have become apart of the culture of black community and it is absolutely horrifying, as I said before, I know very few AA women who have given birth vaginally.

I have to credit my midwife, for showing me and teaching me the beauty of birth. It was my one and one time with her, I really embraced my body and learned about it’s wonderful capacity to grow and birth a beautiful and healthy baby! Through her, I received books, videos and personal testimony. Most of all encouragement and support. How amazing is it that a life can make a change for the better when given personal time and knowledge that comes from a genuine place of help? This is what black women need.

Let me be clear, I’m not advocating home births for all AA, but the empowerment they need to protect themselves from an industry that is hypocritical about it’s Hippocratic oath. Midwives are a wonderful, wonderful resource for this! I can only imagine the drastic change in statistics if midwives were personally involved in the care of pregnant black women, encouraging them with knowledge and accountability.

Here are some interesting statistics…

Washington DC leads the charge with the highest mortality ranking 34.9 per 100,000 live births, yep that’s right…our country’s capital. Georgia comes close with 20.5 per 100,000. The safest place to birth would be Maine, our winner with 1.2 per 100,000 births. Massachusetts is close with 2.7 To see the full chart click here and go to Appendix A.

2 comments:

Yes, midwives would be one helpful solution. Before that, however, I think getting Black women more educated about their options and taking care of themselves is a first step to improving this.

Black women are on the bottom wrung when it comes to many issues especially healthcare. Institutionalized racism in hospitals perpetuates the problems we see plaguing so many pregnant Black women like gestational diabetes and pre-eclampsia. They assume we won't make any changes to avoid or fix those problems so they've stopped disseminating the information. We're just a bunch of ignorant breeders to many of them.

So, we've got to take a grassroots, kitchen table approach to making sure we're all knowledgeable about preparing and maintaining our for and during pregnancy. I'm a breastfeeding advocate as well and all the women I was close to who had children after me, I made sure they knew I was available anytime, any hour for questions or concerns. Those of us who are more informed need to make ourselves available to those who don't.

The other problem with pushing midwives is economics. Unfortunately, the women of color who are typically receive the most disparaging treatment in hospitals cannot afford a midwife.

Having said a mouthful, I do appreciate you addressing this. I will say that more of us who can afford a midwife should consider this option wholeheartedly.

Hi Terri! Thanks for sharing!. Education IS the key, hence the point of my post. Midwives would be a great educational reference resource and personal support outside the discrimination typically faced in the healthcare society.

Without a doubt a grassroots organization would have to occur with some voluntary contribution on the part of midwives.

However, it starts with us...the sooner we refuse to accept furthur asbuse, the sooner change will occur.

I had insurance that covered some my first HB. Then I went unassisted after that. :)

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